2010年山西省忻州市饮水型氟中毒监测结果分析

Analysis of monitoring data of drinking-water borne endemic fluorosis in Xinzhou of Shanxi province in 2010

目的掌握忻州市饮水型氟中毒流行现况，评价改水降氟防治效果，为开展病情监测和制订防治策略提供科学依据。方法将忻州市按照水氟浓度和病区类型分层后，抽取25个病区村作为调查点。在未改水降氟调查村按东、西、南、北、中5个方位各采集1份水样，已改水降氟调查村分别抽取3份居民户末梢水样和1份水源水样，测定水氟。水氟测定按照《生活饮用水标准检验方法》（GB／T5750—2006）。对调查村所有8～12岁儿童进行氟斑牙检查，氟斑牙诊断采用Dean法。对调查村所有16周岁以上人群进行临床氟骨症患病情况检查。抽取调查村中8个村，每村抽取男、女各10人，进行x线氟骨症检查。氟骨症诊断采用《地方性氟骨症诊断标准》（WS／T192—2007）。抽取调查村中13个村的8—12岁儿童，每个年龄段采集6人份尿样，共30人份，采用氟离子选择电极法（WS／T89—2006）测定尿氟。结果未改水村检测水样56份，水氟均值为2．7mg／L；已改水村检测水样52份，水氟均值为1．6mg／L；其中水源水氟〉1．5mg／L的占46．15％（6／13）。儿童氟斑牙检出率未改水村为74．75％（622／832），已改水村为23．67％（241／1018），未改水村与已改水村儿童氟斑牙检出率比较差异有统计学意义（x2=140，P〈0．01）。未改水村氟骨症检出率为30．02％（2803／9335），已改水村为9．44％（1230／13022），二者比较差异有统计学意义（x2=1557．75，P〈0．01）。儿童尿氟几何均数（G）为3．31mg／L，未改水村与已改水村儿童尿氟比较差异有统计学意义（t=2．27，P〈0．05）。结论忻州市饮水型氟中毒病区通过改水降氟病情得到一定控制，但局部病区病情还很严重，部分改水村水氟回升，病情也有上升趋势，须加大监测防治工作力度。

Objective To master the epidemic situation of drinking-water borne endemic fluorosis in Xinzhou, evaluate the effects of water improvement project to reduce fluoride, and to provide a timely scientific basis for monitoring the disease and for establishment of preventive countermeasures. Methods According to the water fluoride concentration and type of the disease, after stratification 25 endemic villages were selected as survey points. Five water samples were collected in water unimproved monitoring villages according to water well locations of east, west, south, north and center. In monitoring villages with improved water, 3 tap water and 1 source water samples were collected, respectively. The fluorine content in water samples was determined according to the ＂Standard Testing Methods for Drinking Water＂ （GB/T 5750-2006）. All children aged 8 to 12 of the survey villages were examined for dental fluorosis by Dean method. Clinical osteofluorosis of all the resident over the age of 16 was examined, 8 villages of these counties were selected, 10 men and women were randomly selected in each village, respectively, and they were examined again by X-ray using ＂Diagnostic Criteria of Endemic Skeletal Fluorosis＂ （WS./T 192-2007）. Children aged 8 to 12 in 13 villages of chosen villages were selected for urine collection, 6 urine samples were collected in each age group and a total of 30 samples were collected., and urinary fluoride was determined by F-ion selective electrode method（WS./T 89-2006）. Results A total of 56 water samples were tested in water-unimproved villages, the average water fluorine was 2.7 mg/L. And 52 water samples were tested in water- improved villages, the average water fluorine was 1.6 mg/L, water fluoride content 〉 1.5 mg/L accounted for 46.15% （6/13） in the water-improved village. Incidences of dental fluorosis of children in the water-unimproved villages and water-improved villages were 74.75% （622/832） and 23.67% （241/1018）, respectively. The difference was statistically significant（x2 = 140, P 〈 0.01 ）. The prevalence rate of skeletal fluorosis was 30.02%（2803/9335） in water-unimproved villages, and 9.44% （1230/13 022） in water-improved villages. The difference was statistically significant（x2 = 1557.75, P 〈 0.01）. The mean of urine fluorine in a total sample was 3.31 mg/L,the urinary fluoride concentration of children in water-improved villages was significantly different from that of water-unimproved villages（t = 2.27 ,P 〈 0.05）. Conclusions By reducing fluorine and improving drinking water, disease in drinking- water borne endemic fluorosis areas in Xinzhou has been controlled to a certain degree. However, the disease is still very serious in some endemic areas. Fluoride in drinking water re-increases in some water-improved villages, the disease is also in a rise. So, the work of monitoring and prevention should be strengthened.